Provider Demographics
NPI:1497486146
Name:ROSE, SIERRA NICOLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIERRA
Middle Name:NICOLE
Last Name:ROSE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3067 HUDSON TER
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34119-3383
Mailing Address - Country:US
Mailing Address - Phone:239-821-8276
Mailing Address - Fax:
Practice Address - Street 1:SACHSEL DENTAL CLINIC
Practice Address - Street 2:151 BODIN CIR BLDG775
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1801
Practice Address - Country:US
Practice Address - Phone:707-423-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205208390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program